Eye bank prepared versus surgeon cut endothelial graft tissue for Descemet membrane endothelial keratoplasty

Regnier, Marie; Auxenfans, Céline; Maucort-Boulch, Delphine; Marty, Anne-Sophie; Damour, O.; Burillon, C.; Kocaba, Viridiana

doi:10.1097/md.0000000000006885

Cited by 27 publications

(15 citation statements)

References 40 publications

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“…There was no significant difference in CCT and ECD between both groups 6 months after surgery. There was one graft failure with precut tissues and four graft failures with surgeon-cut tissues [ 13 ].…”

Section: Discussionmentioning

confidence: 99%

Descemet membrane endothelial keratoplasty (DMEK): clinical results of precut versus surgeon-cut grafts

Koechel

Hofmann

Unterlauft

et al. 2020

Graefes Arch Clin Exp Ophthalmol

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Purpose This study aims to investigate possible differences in clinical outcomes between precut and surgeon-cut grafts for Descemet membrane endothelial keratoplasty (DMEK). Methods 142 consecutive patients who underwent DMEK were included in the study. 44 patients received precut tissues, and 98 patients received surgeon-cut tissues. Precut grafts were allocated to the patient by the German Society for Tissue Transplantation if available. We compared the outcomes of both groups for changes in visual acuity, central corneal thickness, endothelial cell density, re-bubbling rate, and graft failure rate. Results Patients who received precut tissues experienced similar increase in visual acuity (median change 0.4 logMAR) and decrease of corneal swelling (median change 132 μm) compared with those who received surgeon-cut tissues (median VA change 0.3 logMAR, p = 0.55, CCT change 118 μm, p = 0.63). There was no statistical difference in endothelial cell density (1436 vs. 1569 cells/mm2, p = 0.37), re-bubbling (32% vs. 35%, p = 0.85), and graft failure rate (5% vs. 1%, p = 0.23). No primary graft failure occurred in the group of precut grafts. Conclusion Both methods lead to comparable results for visual acuity, corneal deswelling, endothelial cell density, and re-bubbling rate. A previously described higher graft failure rate for precut tissues could not be confirmed in our study. Thus, we do not see medical reasons against the use of precut tissues. There are several advantages of precut DMEK tissues over surgeon-cut tissues, especially the prevention of graft loss during preparation in the operating theater.

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Section: Discussionmentioning

confidence: 99%

Descemet membrane endothelial keratoplasty (DMEK): clinical results of precut versus surgeon-cut grafts

Koechel

Hofmann

Unterlauft

et al. 2020

Graefes Arch Clin Exp Ophthalmol

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“…It is commonly thought that surgeons are more prone to perform posterior lamellar techniques when the risk to damage corneal tissue—due to manual preparation—is very low [ 28 , 29 ]. Previous reports have shown no differences in best corrected visual acuity, central corneal pachymetry or complications—dislocations, primary graft failure—found between corneas prepared by the surgeon in the operating room and precut tissue for DSAEK [ 29 – 31 ] or even DMEK [ 32 ]. Other advantages of precut tissue are the lower rate of microbiological culture positivity and lower risk of receptor infection [ 33 , 34 ].…”

Section: Discussionmentioning

confidence: 99%

Corneal transplantation activity in Catalonia, Spain, from 2011 to 2018: Evolution of indications and surgical techniques

et al. 2021

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Purpose To report corneal transplant activity carried out in Catalonia (Spain) and the evolving indications for keratoplasty over an 8-year period. Methods Annual reports from the Catalan Transplant Organization, Spain, on corneal graft indications and techniques from 2011 to 2018 were reviewed. Results A total of 9457 keratoplasties were performed in Catalonia, from January 2011 to December 2018. The most frequent indications were bullous keratopathy (BK; 20.5%), Fuchs endothelial dystrophy (FED; 17.9%), re-graft (13.7%), and keratoconus (11.3%). Penetrating keratoplasty (PKP) accounted for 63.4% of all performed keratoplasties. Since the introduction of eye bank precut tissue for Descemet stripping automated endothelial keratoplasty (DSAEK) in 2013 and for Descemet membrane endothelial keratoplasty (DMEK) in 2017 the number of endothelial keratoplasties has drastically increased. An increasing trend of posterior lamellar techniques over the total of keratoplasties was found (p<0.001). Endothelial keratoplasties for different endothelial diseases indications (BK, FED, and re-graft), also showed and increasing trend (p<0.001). DMEK is the technique with the highest increase (statistically significantly different from linearity) over other endothelial keratoplasties in FED (p<0.001) but not in BK (p = 0.67) or re-grafts (p = 0.067). Conclusion Endothelial diseases represented the top indication for keratoplasty over the 8-year period. PKP is still the most used technique in Catalonia, but endothelial keratoplasties and especially DMEK showed a significant increasing trend over the last years. This is congruent with the main rationale nowadays for keratoplasties: to customize and transplant as less tissue as possible. Therefore, the availability of precut tissue could have definitely enforced such approach.

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“…Meanwhile, it is suggested that a bias of EC count is possible if different methods were used to evaluate the ECD before and after the surgery (Regnier et al. ; Miron et al. ).…”

Section: Discussionmentioning

confidence: 99%

Significant differences between specular microscopy and corneal bank endothelial cell counts – a pilot study

Rickmann

Boden

Wahl

et al. 2019

Acta Ophthalmologica

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Background: It was shown recently that endothelial cell count performed by cornea banks overestimates the real number of endothelial cells. The aim of this study was to investigate the internal quality of preclinical ECD in human donor corneas using two widely used methods for endothelial cell counting, transmitted light microscopy used in organ culture tissue bank and clinically used specular microscopy. Methods: Twenty human donor corneas that could not be transplanted were included in this analysis. Differences in evaluating endothelial cell density (ECD) and hexagonal endothelial cell ratio (HEX) between clinical specular microscopy (CSM) and corneal bank transmitted light microscope (CBLM) were evaluated as well as differences between automated and manual cell counts. Results: Automated CBLM showed a higher ECD of 31.85% compared to automated CSM, while manual CBLM counting is 10.51% higher compared to manual CSM (p < 0.01). Further, higher average ECD values result in a higher difference between CSM and CBLM measurements. The manual CBLM ECDs were significantly higher compared to automated derived ECD from CSM (p < 0.01). However, no systematic bias can be detected when comparing the differences of the measurements with the average ECD measurements of both methods.Conclusion: This preclinical pilot study confirmed a significant higher ECD using transmitted light microscopy in organ culture compared to clinical specular microscopy. This indicates that the early rapid decrease of EC universally observed after surgery might be partly artefactual.

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Eye bank prepared versus surgeon cut endothelial graft tissue for Descemet membrane endothelial keratoplasty

Cited by 27 publications

References 40 publications

Descemet membrane endothelial keratoplasty (DMEK): clinical results of precut versus surgeon-cut grafts

Descemet membrane endothelial keratoplasty (DMEK): clinical results of precut versus surgeon-cut grafts

Corneal transplantation activity in Catalonia, Spain, from 2011 to 2018: Evolution of indications and surgical techniques

Significant differences between specular microscopy and corneal bank endothelial cell counts – a pilot study

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